Nurse prescribing by children’s nurses: doctors’ views
September 15, 2009 by admin
What do doctors think about nurse prescribing in specialist children’s hospitals? This was one of the questions that this study set out to address, given that increasing numbers of specialist children’s hospital nurses are becoming prescribers.
Interviews with 11 doctors and three clinical leads in one specialist children’s hospital, performed as part of a larger study, revealed that the major benefits were thought to be improved access to medicines and better continuity of care, seen as a particular priority for children and their families. The doctors thought that nurses were able to provide patients with more medicines information than doctors and that nurses were in a better position to develop long-term relationships with their. The authors point out that because nurses at this hospital already worked at an advanced level, and were running their own clinics, prescribing was supporting existing structures.
The concerns of the doctors and clinical leads included: the selection of candidates for prescribing training; the need for doctors to have confidence in the ability of nurses becoming prescribers; clinical skills; and concerns or confusion about roles. It is important that nurses have acquired the appropriate clinical skills before they register for prescribing training. Doctors need to understand nurse prescribing, and good communication across the professional boundaries is vital for this.
Courtenay M and Carey N. Nurse prescribing by children’s nurses: views of doctors and clinical leads in one specialist children’s hospital. J Clin Nursing 2009; 18: 2668-2675.
What barriers to nurse prescribing remain?
July 30, 2009 by admin
It is clear that despite the rapid growth in nurse prescribing, some obstacles remain, particularly in certain clinical areas. Two recent articles discuss some of these issues.
In one [1], the author traces the recent development of nurse prescribing and how it is now being implemented and argues that although it is now mostly supported by doctors, and there has been much progress, some barriers remain.
As predicted, the proportion of nurses qualified to prescribe independently who use supplementary prescribing has fallen since the formulary was opened up. According to Professor Molly Courtenay, that figure is now 20%, down from 40% in 2006, and she points out that some nurses prefer to use supplementary prescribing, to help build confidence and skills, or because their patients have complex conditions.
Some trusts are, however, requiring nurses to practice as supplementary prescribers for a period after qualifying, for a variety of reasons. These policies have their critics and can be seen as frustrating obstacles. Other restrictions include a lack of training and support once nurse prescribers have finished the course, as highlighted by recent research.
Another article [2] discusses nurse prescribing in mental health in Scotland, which has been slow to take off, and shows that evidence about what the barriers are is lacking, concluding that there is an urgent need for research in this area.
[1] Lomas C. Nurse prescribing: The next steps. Nursing Times 2009; 14 July.
[2] Ross J. Researching the barriers to mental health nurse prescribing. Nurse Prescribing 2009; 7(6): 249-253.
Nurse prescribing: therapy areas and CPD needs
June 21, 2009 by admin
Three-quarters of nurses replying to a recent survey about prescribing said that they had CPD needs specifically related to pharmacology, more than 50% to assessment and diagnosis and 44% to knowledge of conditions. Their preferred method for undertaking CPD was e-learning.
The survey took the form of an online questionnaire e-mailed to members of the Association for Nurse Prescribing (ANP), and 62% replied (546 in total). The authors point out that members of the ANP may be particularly likely to be actively prescribing and to be keen to access prescribing support and education.
Nurses reported prescribing for a broad range of conditions, with large numbers of nurses saying that they are now prescribing for pain, respiratory conditions and sexual health - Â in addition to areas identified in previous work such as dermatology - and these areas were among those with most respondents reporting that they had CPD needs.
The authors comment that these results provide useful pointers for those developing and delivering CPD for nurse prescribers and involved in undergraduate training.
Courtenay M and Gordon J. A survey of therapy areas in which nurses prescribe and CPD needs. Nurse Prescribing 2009; 7(6): 255-262.
Prescribing works well for specialist dermatology nurses
May 26, 2009 by admin
Nurse prescribing enhances the care of patients with dermatological conditions, with the benefits being most pronounced for patients of dermatology specialist nurses rather than general practice nurses, according to this case study of consultations between nurse prescribers and patients. The authors also highlight the need for nurses to give patients more information about their medicines if they are to be more involved in the decision-making process.
Interviews, questionnaires and videotaping were used in 10 practice settings across England where nurses prescribe for patients with dermatological conditions. The nurses believed that their prescribing decisions were improved by their holistic assessment approach and better prescribing knowledge. Patients rated their listening and treatment explanation skills, and the assessors who watched the tapes also rated the nurses’ ability to listen and deal sensitively with emotions.
The authors conclude that prescribing allows specialist dermatology nurses to contribute more effectively to dermatology services and that more research is needed to establish whether this is the case for other specialist areas.
Courtenay M, Carey N and Stenner K. Nurse prescriber-patient consultations: a case study in dermatology. J Adv Nursing 2009; 65(6): 1207-1217.
US nurse practitioners widely involved in pharma marketing
April 10, 2009 by admin
A study of US family nurse practitioners found that they were widely involved in pharmaceutical marketing, with more than 75% of the survey respondents saying they accepted gifts. The authors found that that they viewed pharmaceutical company marketing “uncritically as educational and beneficial” and did not see themselves as influenced by this practice, although they thought others would be.
Commenting on the study, Professor Molly Courtenay said she would be surprised if the prescribing practices of UK nurses were influenced by gifts from pharmaceutical companies, as this is a topic addressed within the non-medical prescribing programme. She also pointed out that a number of pharmaceutical companies have developed university-accredited CPD for nurse prescribers - vital for nurses if they are to maintain their prescribing competencies.
Crigger N et al. Nurse practitioners’ perceptions and participation in pharmaceutical marketing. J Adv Nursing 2009; 65(3): 525-533.
http://dx.doi.org/10.1111/j.1365-2648.2008.04911.x
More education about role of nurse prescriber needed
April 10, 2009 by admin
More education of doctors about the role of nurse prescribers is needed to address remaining misunderstandings and concerns, if the full benefits of this development are to be realised and nurse prescribers are to feel supported.
This is the conclusion of a review of recent changes, particularly those affecting community nurses. More than 30,000 nurses in the UK are now qualified to prescribe from the Nurse Prescribing Formulary (NPF) for community practitioners, with many also qualified as independent/supplementary prescribers (NIP/NSP). Although the available evidence suggests that prescribing from the NPF for community practitioners is fairly limited, most of the 14 000 NIP/NSP in the UK prescribe much more regularly, and 20% of these have been reported to be working in the community. In addition, those nurses who do prescribe from the NPF for community practitioners report benefits. As policy changes move healthcare from hospitals into the community, many patients with long-term conditions now see nurses as their first point of contact. Community staff nurses without specialist practitioner qualifications can now access the training needed to prescribe from the NPF for community practitioners, and the increasing numbers of community nurses becoming qualified as NIP/NSP also reflects this shift. The benefits of nurse prescribing exceed those predicted originally by the Department of Health, and more robust training standards are in place. There is still confusion and concerns, however, among doctors about the role, its professional limitations and nurses’ clinical skill base which are at present hampering its implementation more fully.
Courtenay M. Nurse prescribing, policy, practice and evidence base. Br J Comm Nursing 2008; 13(12): 563-566.
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